MINISTRY OF HEALTH AND SOCIAL SERVICES National Strategic Plan for Neglected Tropical Diseases 2015 - 2020 Stark, Sophie, Haikera 2015 January [TYPE THE COMPANY ADDR ESS ] 1 Introduction Namibia is one of the countries in Africa where communicable diseases are diseases of public health importance and the leading causes of morbidity and mortality. The Government of the Republic of Namibia through the Ministry of Health and Social Services has been addressing the major communicable diseases such as malaria, HIV/AIDS, TB, ARI, epidemic prone diseases, Diarrheal disease and other diseases of public health concern with the support of national and international partners and involvement of the community. As a result of this, the country has shown tremendous progress in controlling and decreasing their incidences and prevalence. Moreover, it has reduced malaria morbidity & mortality, HIV prevalence, TB incidence, and infant and child mortality rates. However, some neglected tropical diseases (NTDs), despite being diseases of public importance with known and available preventive and control measures have not received enough attention and concerted efforts as bestowed to the major ones. Understanding the morbidity caused by these diseases and its implication for achieving the MDGs the Ministry of and Social Services has established the Epidemiology Division within the Primary Health Care. The division main aim is to control morbidity and mortality due any communicable diseases of public health interest including Schistosomiasis, Soil Transmitted Helminthes to a level where they are no longer diseases of public health importance. The Ministry of Health and Social Services is also in a process to establish a Public Health laboratory in order to strengthen diagnostic and surveillance capacity and eventually contribute to improved response in the country. Though partial mapping was done for some of the PCT-NTDs, the epidemiology and distribution of NTDs in Namibia is still unknown. As the burden and occurrence of the NTDs can be minimized with safe and effective prevention and treatment strategies such as preventive chemotherapy and vector control, for an effective intervention, understanding their distribution is of paramount importance since mapping is the first step that determines the distribution of NTDs prior to interventions. 2 Part 1: Situation analysis 1.1 Country Profile 1.1.1 Administrative, demographic and community structures On March 21, 1990 Namibia achieved its independence after a century of colonial rule, first by Germany and then by South Africa, following the successful implementation of United Nations Resolution 435. With a constitution based on Roman-Dutch law, the country has a multi-party system and holds general elections every five years. A bicameral legislature consists of the National Council (two members chosen from each regional council) and the National Assembly. Administratively, the country is divided into 13 regions, namely: Zambezi, Kavango east, Kavango West, Kunene, Ohangwena, Omusati, Oshana, and Oshikoto regions in the north; Omaheke, Otjozondjupa, Erongo, and Khomas regions in the central areas; and the Hardap and Karas regions in the south. According to the 2001 Population and Housing Census, the Namibian population consists of 1,830,330 people, of which 942,572 are female and 887,721, are male (Table 1.1). The country has a relatively young population, with 43 percent under 15 years of age and less than 4 percent over age 65. Despite rapid urbanization, Namibia is still mainly rural, with one in three living in urban areas. Overall, the population density is low (2 persons per square kilometer). Regional population densities vary substantially, with almost two-thirds of the population living in the four northern regions and less than one-tenth living in the south. Despite its small population, Namibia has a rich diversity of ethnic groups. English is the official language but there are more than 11 indigenous languages in Namibia. 3 Table1. National population data, Schools and health facilities at district level Province or District No. of Total Under 5-14 No. of No. of region villages or population fives years primary peripheral communities schools health facilities * Caprivi Katima Mulilo 100,528 14,074 23,121 32 Erongo Omaruru 19,415 2,718 4,465 6 Erongo Swakopmund 42,590 5,963 9,796 14 Erongo Usakos 16,499 2,310 3,795 9 Erongo Walvis Bay 54,897 7,686 12,626 20 Hardap Aranos 11,337 1,587 2,608 3 Hardap Mariental 39,203 5,488 9,017 9 Hardap Rehoboth 33,576 4,701 7,723 10 Karas Karasburg 19,071 2,670 4,386 6 Karas Keetmanshoop 38,465 5,385 8,847 10 Karas Luderitz 27,324 3,825 6,285 12 Kavango Andara 37,047 5,187 8,521 10 Kavango Nankudu 62,471 8,746 14,368 13 Kavango Nyangana 34,041 4,766 7,829 11 Kavango Rundu 147,680 20,675 33,966 26 Khomas Windhoek 316,508 44,311 72,797 41 Kunene Khorixas 17,400 2,436 4,002 9 Kunene Opuwo 54,768 7,668 12,597 16 Kunene Outjo 19,264 2,697 4,431 4 Ohangwena Eenhana 84,382 11,813 19,408 12 Ohangwena Engela 196,126 27,458 45,109 19 Ohangwena Okongo 28,052 3,927 6,452 5 Omaheke Gobabis 95,010 13,301 21,852 16 Omusati Okahao 35,511 4,972 8,168 11 Omusati Oshikuku 124,673 17,454 28,675 19 Omusati Outapi 83,320 11,665 19,164 13 Omusati Tsandi 45,610 6,385 10,490 11 Oshana Oshakati 211,031 29,544 48,537 21 Oshikoto Onandjokwe 186,393 26,095 42,870 18 Oshikoto Tsumeb 30,465 4,265 7,007 7 Otjozondjupa Grootfontein 51,256 7,176 11,789 9 Otjozondjupa Okahandja 35,527 4,974 8,171 4 Otjozondjupa Okakarara 29,411 4,117 6,764 7 Otjozondjupa Otjiwarongo 73,799 10,332 16,974 9 4 1.1.2 Geographical characteristics Namibia is situated in South-Western Africa and covers approximately 824,000 square kilometers. It is bordered by the Atlantic Ocean in the west, Botswana and Zimbabwe in the east, South Africa in the south, and Angola and Zambia in the north. The Namib Desert, the oldest desert in the world, stretches along the whole west coast of the country, while the Kalahari Desert runs along the southeastern border with Botswana. Namibia’s name is derived from the Namib Desert, a unique geological feature renowned for the pristine and haunting quality of its landscape. The Namibian climate varies from arid and semi-arid to subtropical with temperatures between 5°C and 20°C. Fog sometimes occurs along the temperate desert coast. The central, southern, and coastal areas constitute some of the most arid landscapes south of the Sahara. The hottest months of the year are January and February, with average daytime temperatures varying between 9°C and 30°C. During the winter months, May to September, temperatures can fluctuate between -6°C and 10°C at night to 20°C in the day. Frost occurs over large areas of the country during winter, but in general, winter days are clear, cloudless and sunny. Overall, Namibia is a summer rainfall area with limited showers beginning in October and continuing until April. 1.1.3 Socio economic status and indicators The positive global economic performance between 2002 and 2006 had a favorable impact on the Namibian economy mainly through high commodity prices and strong demand from the rest of the world. In real terms, the economy recorded a growth rate of 6 percent in 2004, above the 4.4 percent projected earlier. On average, the economy grew by 4.6 percent between 2001 and 2004, just above the target rate of 4.3 percent set in National Development Plan 2 (NDP2). Taking into account the prospects of the world economy and that of Namibia’s main trading partners, the outlook for the Namibian economy for the coming years points to moderate economic performance with a projected average annual growth rate of 3.7 percent (Ministry of Finance, 2007). The economy of Namibia, which was formerly based on natural resources, is slowly becoming more diversified. This change is partly a result of the increased processing of minerals such as diamonds, zinc, copper, and marble. In addition, tourism sector has been expanding very rapidly in the past decade, e.g., preliminary amounts indicate that travel and tourism’s contribution to GDP increased by 9.3 percent (real growth) in 2007 alone. Agricultural growth has a disproportionate effect on reducing poverty because 70 percent of the poor in developing countries, including Namibia, live in rural areas. Namibia, along with its developing-country partners, has long championed the reduction of trade barriers for agricultural products as one of the most important actions to reduce poverty. The manufacturing sector in Namibia remains small, with fish and meat processing being the largest individual sub-sectors. Beverages, other food products, metal and 5 pre-cast concrete products, furniture, paints, detergents, and leather goods are also produced. Namibia is ranked as a middle-income country but has one of the most skewed incomes per capita in the world. The disparities in per capita income among the population are as a result of lopsided development, which characterized the Namibian economy in the past. The country also has a high unemployment rate, which is estimated at 37 percent (Ministry of Labour and Social Welfare, 2004). 1.1.4 Transportation and communication The Namibian transport system is extensive and reaches most parts of the country by road, rail, or air. The main North-South axis by road connects the central parts of Namibia including the capital Windhoek with the South African border in the South and the Angolan border in the North.